Evolving patterns in the surgical treatment of malignant ventricular tachyarrhythmias.
The advent of the automatic implantable cardioverter defibrillator (AICD), generally viewed as a safe and effective intervention, has in some measure discouraged the use of electrophysiologically directed endocardial resection for intractable ventricular arrhythmias. We reviewed the records of 127 patients undergoing either AICD procedures or resection over a 6-year period. Thirty-day mortality was 5.6% (5/89 patients) for all AICD procedures, 10.7% (3/28) for AICD placement plus coronary artery bypass grafting, and 11.8% (4/34) for resection. These mortality figures are not significantly different. Patients undergoing resection were less likely to require antiarrhythmic agents than patients given an AICD (33% versus 61%). Survival at 2 years was 78% in the resection group and 72% in the AICD group. Survival at 4 years was still 78% in the resection group. Only 1 late sudden death occurred in the AICD group and none in the resection group. We conclude that resection continues to be a valuable alternative, offering a greater overall benefit at only slightly increased risk.
Elefteriades
J A
JA
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
Biblo
L A
LA
Batsford
W P
WP
Rosenfeld
L E
LE
Henthorn
R W
RW
Carlson
M D
MD
Waldo
A L
AL
Hsu
J
J
Geha
A S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy